РОЛЬ МСКТ И МРТ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ ОСЛОЖНЕНИЙ СРЕДНЕЙ ЗОНЫ ЛИЦА У ПАЦИЕНТОВ С ПАТОЛОГИЕЙ ГРИБКОВОЙ ЭТИОЛОГИИ

Abstract

Abstract. Introduction. Fungi are one of the constituents of an ecosystem. There are about 250 known human- pathogenic fungi species: From the widely spread Candida to the pathogene of aspergillosis that may lead to fatal consequences in certain conditions. Studies performed by Russian and foreign authors show the increase in the frequency of chronic sinusitis determined by the presence of fungi or fungal-microbial associations. Aim of this study is to perform the differential diagnosis of midface complications in patients with fungal pathology according to multispiral computed tomogrsphy and magnetic resonance tomography. Materials and Methods. A retrospective study was conducted based on the findings of multispiral computed and/or magnetic resonance tomographies of 68 patients. Presence of a fungal process was confirmed by histopathologic, mucroscopic, and cultural investigations. Results and Discussion. Histological investigations of surgical specimen detected the presence of fungal bodies formed by mycelium, i.e., a cluster of densely, compactly located fungal flocci in 28 of 48 (58.3 %): In 28 patients with maxilla sinus lesions, in 14 patients with sohenoidal sinus lesions, and in 5 patients with ethmoidal sinus lesions. In case of acute invasive fungal rhinosinusitis, the computed tomography of paranasal sinuses detected mucosal thickening and the bone density decrease associated with an erosive process. Unilateral lesions, erosions, and thinning of the sinus bone walls. According to magnetic resonance tomography, there was low signal in T2 mode, which is determined by the high concentrations of various metal elements in fungi, as well as by a high protein level and low free water contents in mucine. Conclusions. Visualization is essential to staging the disease and assessing the involvement of deeper structures, which may be clinically unmanifest. Although both computed tomography and magnetic resonance tomography are useful, the contrast-enhanced magnetic resonance tomography is the method of choice and helps assess the spread of the disease, especially regarding the deep extension into maxilla-facial area and brain.